Lee Kuo-Hua, Chen Yung-Tai, Chung Hsiao-Jen, Liu Jia-Sin, Hsu Chih-Cheng, Tarng Der-Cherng
a School of Medicine, National Yang-Ming University , Taipei , Taiwan .
b Division of Nephrology , Department of Medicine, Taipei Veterans General Hospital , Taipei , Taiwan .
Ren Fail. 2016;38(1):77-83. doi: 10.3109/0886022X.2015.1103638. Epub 2015 Oct 29.
To compare the renal outcomes in patients of unilateral renal cell carcinoma (RCC) with upper tract urothelial carcinoma (UTUC) following surgical resection of the tumor-bearing kidney, and to investigate the potential predictors in renal function decline.
In this retrospective cohort study, 319 RCC patients undergoing radical nephrectomy (RN) and 297 UTUC patients undergoing radical nephroureterectomy were recruited from a tertiary medical center between 2001 and 2010. Demographic data, co-morbidity, smoking habit, baseline estimated glomerular filtration rate (eGFR) calculated by chronic kidney disease-epidemiology equation, as well as tumor staging of RCC and UTUC, were recorded. The primary endpoint was serum creatinine doubling and/or end-stage renal disease (ESRD) necessitating long-term dialysis. Cox proportional hazard model and Fine and Gray's competing risk regression accounting for death were used to model renal outcome.
UTUC patients had a higher incidence rate of renal function deterioration than RCC patients did (15.01 vs. 2.68 per 100 person-years, p<0.001). In Cox proportional hazard model and Fine and Gray's competing risk regression, UTUC was significantly associated with increased risk of creatinine doubling and/or ESRD necessitating dialysis (hazard ratio, 3.13; 95% confidence interval, 2.01-4.87) as compared to RCC following unilateral RN. Nevertheless, our study is observational in nature and cannot prove causality.
UTUC per se is strongly associated with kidney disease progression as compared to RCC following unilateral nephrectomy. Further studies are needed to elucidate this association.
比较单侧肾细胞癌（RCC）患者与上尿路尿路上皮癌（UTUC）患者在切除患肾后的肾脏转归，并探讨肾功能下降的潜在预测因素。
在这项回顾性队列研究中，2001年至2010年间从一家三级医疗中心招募了319例行根治性肾切除术（RN）的RCC患者和297例行根治性肾输尿管切除术的UTUC患者。记录人口统计学数据、合并症、吸烟习惯、根据慢性肾脏病流行病学方程计算的基线估计肾小球滤过率（eGFR），以及RCC和UTUC的肿瘤分期。主要终点是血清肌酐翻倍和/或需要长期透析的终末期肾病（ESRD）。采用Cox比例风险模型以及考虑死亡因素的Fine和Gray竞争风险回归模型对肾脏转归进行建模。
UTUC患者肾功能恶化的发生率高于RCC患者（每100人年分别为15.01和2.68，p<0.001）。在Cox比例风险模型和Fine和Gray竞争风险回归模型中，与单侧RN后的RCC相比，UTUC与肌酐翻倍和/或需要透析的ESRD风险增加显著相关（风险比为3.13；95%置信区间为2.01 - 4.87）。然而，我们的研究本质上是观察性的，无法证明因果关系。
与单侧肾切除术后的RCC相比，UTUC本身与肾脏疾病进展密切相关。需要进一步研究以阐明这种关联。
